Background and Goal of Study:
Temporary Portocaval shunt TPCS is a surgical procedure to help reduce gut congestion in post dissection
phase of LDLT. Aim is to evaluate the effects of TPCS on systemic haemodynamics and
laboratory parameters during the anhepatic and reperfusion phases.
Materials and Methods:randomized control study after ethical comity approval and consent, registered
at Pan African Clinical Trial Registry(PACT201712002857722). 64 LDLT, (4 excluded for portal vein
extended thrombosis), TPCS S gp (n=30), no shunt C gp (n=30).Post induction Trans esophageal
Doppler probe is applied TED(Cardio Q, Deltex, Chichester, UK).Haemodynamic, TED parameters
(cardiac output CO l/min, systemic vascular resistance SVR dyns/s/cm-5\min), arterial blood gases (pH,
bicarbonate HCO3 mmol/l), serum lactate (mg/dl), dose of vasoactive drugs are reported at: post
induction base line (T0), at end of the anhepatic phase (T1) and 5 minutes postreperfusion(
T2).Postoperative 24h (T3). New grafted liver enzymes, blood lactate and complications
were monitored.
Results and Discussion:
MELD score and age were comparable S gp vs C gp (16[15-18] vs.15 [12-17.7] P= 0.055, 49.5[45-52]
vs. 47.5[42.25-51.7] P=0.36), respectively.
At (T1): median [IQR] arterial pH values, was comparable (S gp vs. C gp) 7.32[7.24-7.31] vs. 7.29[7.25-
7.33]
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At (T2) CO, pH, HCO3 were significantly higher with S gp vs. C gp (CO) 7.6 [6.3-8.6] vs. 6.1 [5.4-7.2],
(pH) 7.28[7.24-7.31] vs. 7.20 [7.19-7.25] P=0.001), (HCO3) 20.7[18.6-23] vs.16.5 [14-18.7] P= 0.001),
respectively.
At (T3) the liver enzymes show no change between 2 gps, while blood Lactate levels (mg/dl) were
significantly less with S gp compared to C gp (27.02[18-39] vs. 50[40-82], P= 0.001
More total noradrenaline support (Nor/mg) were required during anhepatic phase and throughout the
procedure guided with TED to support mean BP and SVR in C gp compared to S gp, (Nor/mg 6[0-12] vs.
3.6[0-6] P= 0.03) respectively. Significantly less adrenaline boluses during (T2) were required in S gp vs
C gp (17±1 vs. 45± 20 ᶬgm P= 0.001). Packed red cells were comparable (2[0-4] vs. 2[0-6.7] units, P=
0.31.) Warm ischemia time was longer in S gp vs. C (51.1+14 vs. 44.12+16 mins, P= 0.01). 24 h
postoperative liver enzymes were comparable (P= 0.6)
Conclusion(s):TPCS reduces acidosis,doses of vasoactive drugs needed to support haemodynamics
during anhepatic phase and reduces reperfusion injery.

04 / The effects of Temporary Portocaval shunt during live donor liver transplantation on the haemodynamics and laboratory parameters of the anhepatic and reperfusion phases.
